Department of Neurology, "Sant'Elia" Hospital, ASP Caltanissetta, Via Luigi Russo, 6, 93100, Caltanissetta, Italy.
Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia, 78, 95125, Catania, Italy.
BMC Neurol. 2019 Aug 13;19(1):193. doi: 10.1186/s12883-019-1417-0.
Emotional processes and responses are underestimated in stroke patients because the massive clinical picture of large hemispheric strokes often hides these symptoms. We report on a patient with peculiar unpleasant emotional responses after temporal stroke.
We describe a 62-years old man with significant unpleasant emotional responses that occurred after an acute episode of confusional state, disorientation, agitation, vertigo, postural instability, vomiting, and photophobia. Since then, he complained that vision of pictures containing curved/multicolored lines or tangles was associated with an uncomfortable feeling of fear and disgust, lasting few minutes, so that he avoided looking at them. Notably, he also showed an abnormal facial expression of disgust and fear, together with neurovegetative reaction and horripilation, at the presentation of pictures of objects or animals containing curved, multicolored, or tangled lines. A post-acute infarction of the right temporal-insular region, together with mild periventricular white matter changes, were evident at the brain magnetic resonance imaging.
The anterior insula is crucial in transforming unpleasant sensory input into visceromotor reactions and the accompanying feeling of disgust. It is also known that temporal pole modulates visceral emotional functions in response to emotionally evocative perceptual stimuli. In the present case, the ischemic lesion of anterior part of the insula and temporal pole may have caused a decoupling of emotional and visceral response to complex visual stimuli. Further reports will provide a significant contribution to the taxonomy of these complex and relatively uncommon non-motor post-stroke symptoms that negatively affect quality of life.
由于大面积半球性中风的大量临床症状常常掩盖了这些症状，因此中风患者的情绪过程和反应被低估了。我们报告了一例颞叶中风后出现特殊不愉快情绪反应的患者。
我们描述了一位 62 岁男性，在急性意识状态混乱、定向障碍、躁动、眩晕、姿势不稳、呕吐和畏光发作后出现明显的不愉快情绪反应。从那时起，他抱怨说看到含有弯曲/多色线或纠结线的图片会引起不舒服的恐惧和厌恶感，持续几分钟，因此他避免看这些图片。值得注意的是，他还表现出异常的厌恶和恐惧面部表情，以及神经植物反应和毛发竖立，当呈现含有弯曲、多色或纠结线的物体或动物图片时。大脑磁共振成像显示右侧颞叶-岛叶区域的急性梗塞后，伴有轻度脑室周围白质变化。
前岛叶在将不愉快的感觉输入转化为内脏运动反应和随之而来的厌恶感方面起着至关重要的作用。众所周知，颞极在对情感唤起的感知刺激做出反应时调节内脏情感功能。在本例中，岛叶和颞极前部的缺血性病变可能导致对复杂视觉刺激的情感和内脏反应脱钩。进一步的报告将对这些复杂且相对不常见的非运动性中风后症状进行分类，这些症状对生活质量产生负面影响，提供重要贡献。
